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International Journal of Critical... 2024Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due...
BACKGROUND
Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due to age, gender, and years of dialysis treatment among patients undergoing hemodialysis (HD).
METHODS
A cross-sectional study was carried out in 2023 using the Johns Hopkins Fall Risk Assessment tool. Participants were recruited from the HD unit at a tertiary care academic medical center in Ajman, UAE. Data were analyzed between different ages, genders, and years on HD categories with or without medication factors.
RESULTS
Data were collected and analyzed for 44 patients. The fall risk of the study population assessed with the Kruskal-Wallis test showed no difference between different age groups ( = 0.43) but did show a significant difference when the score of medication factor was removed from the fall risk estimation ( = 0.002). A pairwise analysis showed fall risk score of the age group 46-60 years was differing from the age cohort >60 ( < 0.001). A positive moderate correlation (Spearman's correlation coefficient 0.514 was found, with a < 0.001) was seen with an increase in age and fall risk only when the medication factor was removed from the fall risk estimation. Results on gender or duration of dialysis were insignificant.
CONCLUSION
Medication factors being a significant contributor to fall risk among the study population was found to mask the fall risk difference between age groups 46-60 years and >60 years. Such influence was not found for gender or duration of dialysis.
PubMed: 38715751
DOI: 10.4103/ijciis.ijciis_57_23 -
The Journal of Emergency Medicine May 2024Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury. (Observational Study)
Observational Study
BACKGROUND
Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.
OBJECTIVE
This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall-related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.
METHODS
We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall-related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1-3), vulnerable-frail (CFS score 4-6), and severely frail (CFS score 7-9).
RESULTS
A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4-16.8]; p = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44-3.45; p = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41-13.6; p = 0.34) in those considered severely frail.
CONCLUSIONS
This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.
Topics: Humans; Accidental Falls; Female; Male; Aged; Aged, 80 and over; Prospective Studies; Frailty; Emergency Service, Hospital; Frail Elderly; Craniocerebral Trauma
PubMed: 38714480
DOI: 10.1016/j.jemermed.2024.01.005 -
Journal of Preventive Medicine and... Mar 2024Falling is a serious problem for all ages. There are several tests to assess balance. Mini-BESTest and brief-BESTest are balance tests for which there are no normative...
INTRODUCTION
Falling is a serious problem for all ages. There are several tests to assess balance. Mini-BESTest and brief-BESTest are balance tests for which there are no normative values for Iranian people. We aimed to provide the normative values of mini-BESTest and brief-BESTest among healthy Iranian adults.
METHODS
A cross-sectional study was designed. Three hundred healthy adults (150 males and 150 females) in six age groups (18-29, 30-39, 40-49, 50-59, 60-69, +70 years) completed the tests using Persian mini-BESTest and brief-BESTest. Normative values were calculated for age groups.
RESULTS
Normative values of mini-BESTest and brief- BESTest decreased significantly with age (from 27 to 21.9 for mini-BESTest and from 22.9 to 15.4 for brief BESTest). There were no significant differences between genders except for females in 30-39 and 40-49 years age groups which scored better on brief-BESTest and mini-BESTest, respectively. Males had significantly scored better in brief- BESTest in 60-69 and ≥ 70 age groups.
CONCLUSIONS
The normative values of the mini-BESTest and brief-BESTest provided for healthy Iranian adults can help clinicians when assessing subjects with balance dysfunction.
Topics: Humans; Male; Female; Adult; Iran; Middle Aged; Cross-Sectional Studies; Aged; Young Adult; Postural Balance; Adolescent; Reference Values; Accidental Falls; Age Factors
PubMed: 38706770
DOI: 10.15167/2421-4248/jpmh2024.65.1.3051 -
Gait & Posture Jun 2024To complement traditional clinical fall risk assessments, research is oriented towards adding real-life gait-related fall risk parameters (FRP) using inertial sensors...
BACKGROUND
To complement traditional clinical fall risk assessments, research is oriented towards adding real-life gait-related fall risk parameters (FRP) using inertial sensors fixed to a specific body position. While fixing the sensor position can facilitate data processing, it can reduce user compliance. A newly proposed step detection method, Smartstep, has been proven to be robust against sensor position and real-life challenges. Moreover, FRP based on step variability calculated from stride times (Standard deviation (SD), Coefficient of Variance (Cov), fractal exponent, and sample entropy of stride duration) proved to be useful to prospectively predict the fall risk.
RESEARCH QUESTIONS
To evaluate whether Smartstep is convenient for calculating FRP from different sensor placements.
METHODS
29 elderly performed a 6-minute walking test with IMU placed on the waist and the wrist. FRP were computed from step-time estimated from Smartstep and compared to those obtained from foot-mounted inertial sensors: precision and recall of the step detection, Root mean square error (RMSE) and Intraclass Correlation Coefficient (ICC) of stride durations, and limits of agreement of FRP.
RESULTS
The step detection precision and recall were respectively 99.5% and 95.9% for the waist position, and 99.4% and 95.7% for the wrist position. The ICC and RMSE of stride duration were 0.91 and 54 ms respectively for both the waist and the hand position. The limits of agreement of Cov, SD, fractal exponent, and sample entropy of stride duration are respectively 2.15%, 25 ms, 0.3, 0.5 for the waist and 1.6%, 16 ms, 0.23, 0.4 for the hand.
SIGNIFICANCE
Robust against the elderly's gait and different body locations, especially the wrist, this method can open doors toward ambulatory measurements of steps, and calculation of different discrete stride-related falling risk indicators.
Topics: Humans; Accidental Falls; Aged; Male; Female; Risk Assessment; Gait; Accelerometry; Monitoring, Ambulatory; Aged, 80 and over
PubMed: 38705036
DOI: 10.1016/j.gaitpost.2024.04.036 -
Journal of Biomechanics May 2024As the recovery from gait perturbations is coordinatively complex and error-prone, people often adopt anticipatory strategies when the perturbation is expected. These...
As the recovery from gait perturbations is coordinatively complex and error-prone, people often adopt anticipatory strategies when the perturbation is expected. These anticipatory strategies act as a first line of defence against potential balance loss. Since age-related changes in the sensory and neuromotor systems could make the recovery from external perturbations more difficult, it is important to understand how older adults implement anticipatory strategies. Therefore, we exposed healthy young (N = 10, 22 ± 1.05 yrs.) and older adults (N = 10, 64.2 ± 6.07 yrs.) to simulated slips on a treadmill with consistent properties and assessed if the reliance on anticipatory control differed between groups. Results showed that for the unperturbed steps in between perturbations, step length decreased and the backward (BW) margin of stability (MOS) increased (i.e., enhanced dynamic stability against backward loss of balance) in the leg that triggered the slip, while step lengths increased and BW MOS decreased in the contralateral leg. This induced step length and BW MOS asymmetry was significantly larger for older adults. When exposed to a series of predictable slips, healthy older adults thus rely more heavily on anticipatory control to proactively accommodate the expected backward loss of balance.
Topics: Humans; Male; Female; Postural Balance; Middle Aged; Aged; Gait; Accidental Falls; Adult; Aging; Anticipation, Psychological; Biomechanical Phenomena; Young Adult; Walking
PubMed: 38703516
DOI: 10.1016/j.jbiomech.2024.112122 -
Osteoporosis International : a Journal... Jul 2024To study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke. (Observational Study)
Observational Study
PURPOSE
To study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke.
METHODS
Observational cohort study of adults aged ≥ 50 years admitted with ischaemic stroke over a 12-month period were invited to participate in a telephone interview one-year post-stroke to ascertain falls and fracture. A Fracture Risk After Ischaemic Stroke (FRAC-stroke) score was calculated.
RESULTS
Of the 1267 patients admitted to the stroke unit between 1 January 2020 and 31 December 2020, 624 had a modified Rankin Score documented. Of these, 316 adults ≥ 50 years had ischaemic stroke and 131 consented to a telephone interview. Mean age was 72.4 ± 10.7 years and 36.6% were female. 34 patients (25.9%) had a FRAC-stroke score of ≥ 15, equating to ≥ 5% risk of fracture in the year following stroke. Eleven (8.4%) patients (6 female) had a minimal trauma fracture in the 12 months post-stroke. There was a significant difference in patients experiencing falls pre- and post-stroke (19.8% vs 31.3%, p = 0.04). FRAC-stroke score was higher in those who had a fracture post stroke compared those who did not (20.4 vs 8.9, p < 0.001). Receiver operating characteristic analysis found an area under the curve of 0.867 for FRAC-stroke score (95% CI 0.785-0.949, p < 0.005). The optimal cutoff value for FRAC-stroke score predicting fracture was 12 with a sensitivity of 90.9% and specificity of 70%.
CONCLUSION
The FRAC-stroke score is a simple clinical tool that can be used to identify patients at high risk of fracture post-stroke who would most benefit from osteoporosis therapy. Stroke is a risk factor for fracture due to immobilisation, vitamin D deficiency and increased falls risk. This study found that a simple bedside tool, the FRAC-stroke score, can predict fracture after ischaemic stroke. This will allow clinicians to plan treatment of osteoporosis prior to discharge from a stroke unit.
Topics: Humans; Female; Male; Aged; Osteoporotic Fractures; Accidental Falls; Risk Assessment; Middle Aged; Ischemic Stroke; Osteoporosis; Aged, 80 and over; Cohort Studies; Prevalence; Risk Factors
PubMed: 38703219
DOI: 10.1007/s00198-024-07099-0 -
Hepatology Communications May 2024Frailty is a predictive factor of hospitalization, falls, and mortality in patients with cirrhosis, regardless of the degree of liver failure. The aim was to analyze... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Frailty is a predictive factor of hospitalization, falls, and mortality in patients with cirrhosis, regardless of the degree of liver failure. The aim was to analyze whether a multifactorial intervention consisting of home-based exercise, branched-chain amino acids, and a multistrain probiotic can improve frailty in these patients.
METHODS
Outpatients with cirrhosis were classified according to the Liver Frailty Index (LFI). Prefrail and frail patients were randomized into 2 groups. The intervention group was assigned to a multifactorial intervention consisting of exercise at home, branched-chain amino acid supplements, and a multistrain probiotic for 12 months. The control group received standard care. All patients were prospectively followed up every 3 months for 1 year to determine LFI, incidence of falls, emergency room visits, hospitalizations, and mortality.
RESULTS
Thirty-two patients were included: 17 patients were assigned to the intervention group and 15 to the control group. In the intervention group, the baseline LFI decreased at 3, 6, 9, and 12 months (p = 0.019 for overall change with respect to the control group). The change in LFI (ΔLFI) at 12 months was -0.71 ± 0.24 in the intervention group and -0.09 ± 0.32 in the control group (p<0.001). During follow-up, patients in the intervention group had a lower 1-year probability of falls (6% vs. 47%, p = 0.03) and emergency room visits (10% vs. 44%, p = 0.04) than patients in the control group.
CONCLUSIONS
A long-term multifactorial intervention that included exercise at home, branched-chain amino acids, and a multistrain probiotic improved frailty in outpatients with cirrhosis and was associated with a decrease in the incidence of clinical events such as falls and emergency room visits.
Topics: Humans; Male; Female; Liver Cirrhosis; Amino Acids, Branched-Chain; Probiotics; Frailty; Middle Aged; Aged; Hospitalization; Accidental Falls; Exercise Therapy; Prospective Studies; Treatment Outcome; Dietary Supplements
PubMed: 38701490
DOI: 10.1097/HC9.0000000000000443 -
BMC Geriatrics May 2024The association between vitamin D supplementation and the risk of falls in older adults has been controversial. This systematic review and network meta-analysis aims to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between vitamin D supplementation and the risk of falls in older adults has been controversial. This systematic review and network meta-analysis aims to assess the efficacy of vitamin D, calcium, and combined supplementation in the prevention of falls.
METHODS
Randomized controlled trials (RCTs) on the efficacy of vitamin D in fall prevention were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science from inception to May 9, 2023. The network meta-analysis was performed using a random effects model in R4.1.3 and Stata15.0. Heterogeneity was evaluated by the I statistic, and publication bias was assessed using funnel plots, Begg's test, and Egger's tests. Data were pooled and expressed as relative risk (RR) and 95% confidence interval (CI).
RESULTS
A total of 35 RCTs involving 58,937 participants were included in this study, among which 11 RCTs (31.4%) applied calcium combined with vitamin D. There was low heterogeneity (I = 11%) among the included studies. Vitamin D supplementation at 800-1000 International Unit (IU)/d resulted in a lower risk of falls than placebo or no treatment (RR = 0.85, 95%CI: 0.74-0.95). In addition, 800-1000 IU/d of vitamin D with or without calcium were more effective in preventing falls than calcium alone. High-dose vitamin D (> 1000 IU/day) increased the risk of falls compared with 800-1000 IU/d of vitamin D. According to the subgroup analysis, daily administration of 800-1000 IU/d vitamin D was associated with a 22% reduction in the risk of falls (RR = 0.78, 95%CI:0.64-0.92), whereas intermittent vitamin D administration had no preventive effect. Furthermore, 800-1000 IU/d of vitamin D also significantly decreased the risk of falls in old adults with ≤ 50 nmol/L 25-hydroxyvitamin D [25(OH)D] (RR = 0.69, 95%CI:0.52-0.86) but not in individuals with > 50 nmol/L 25(OH)D.
CONCLUSION
Vitamin D supplementation at 800-1000 IU/d is associated with a lower risk of falls among older adults. 800-1000IU/d of vitamin D has a benefit on prevention of falls in population received daily dose regimens and in population with vitamin D deficiency.
Topics: Accidental Falls; Humans; Vitamin D; Dietary Supplements; Network Meta-Analysis; Aged; Randomized Controlled Trials as Topic; Calcium; Vitamins
PubMed: 38698349
DOI: 10.1186/s12877-024-05009-x -
Contemporary Clinical Trials Jul 2024A 12-week multicomponent frailty management program - Say No To Frailty (SNTF) consisting of interactive talks and fitness exercises led by a trained program leader has... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical effectiveness and cost-effectiveness of a multicomponent frailty management program "Say No To Frailty" in Singapore: A cluster-randomized controlled trial protocol.
BACKGROUND
A 12-week multicomponent frailty management program - Say No To Frailty (SNTF) consisting of interactive talks and fitness exercises led by a trained program leader has shown feasibility and positive health outcomes in community-living older adults with frailty and pre-frailty in Singapore. This study aims to evaluate the clinical- and cost-effectiveness of SNTF on physical functions, self-confidence, community participation, quality of life and fall reduction in the local community setting.
METHODS
This study will use the cluster-randomization method to randomly allocate 12 participating centres into three arms. Centres under two intervention arms will conduct the same SNTF program but led by a program leader with different training backgrounds (an Allied Health Professional (AHP) v.s. a non-AHP), whereas centres under the control arm will continue their usual care without an additional intervention. Eligible participants at each participating centre will be recruited via the convenience sampling method in the community setting. Primary outcome measure (frailty level) and secondary outcome measures (e.g., physical functions, self-confidence, community participation, quality of life) will be conducted by the blinded assessors at baseline, immediate, 3 months and 9 months post-intervention. Fall data will be collected during the one-year study period. Outcomes between and within groups will be compared and analysed using STATA to evaluate the clinical effectiveness. Program costs and relevant healthcare costs during the follow-up phase will be recorded for cost-effectiveness analysis.
CONCLUSION
This study will provide significant insights into conducting SNTF for Singapore community-living older adults with frailty and pre-frailty on clinical- and cost-effectiveness. Australia New Zealand Clinical Trials Registry: ACTRN12621001673831.
Topics: Humans; Cost-Benefit Analysis; Singapore; Quality of Life; Aged; Frailty; Frail Elderly; Independent Living; Accidental Falls; Exercise Therapy; Male; Female; Aged, 80 and over; Self Concept
PubMed: 38697512
DOI: 10.1016/j.cct.2024.107546 -
BMJ Open May 2024Falls are common in older people and individuals with neurological conditions. Parkinson's disease (PD) is known for postural instability causing mobility disabilities,...
Role of virtual reality in examining the effect of fear of falling (FOF) on postural stability in individuals without and with Parkinson's disease in Egypt: a mixed-methods feasibility study protocol.
BACKGROUND
Falls are common in older people and individuals with neurological conditions. Parkinson's disease (PD) is known for postural instability causing mobility disabilities, falls and reduced quality of life. The fear of falling (FOF), a natural response to unstable balance, can worsen postural control problems. Evaluating FOF relies largely on affected persons' subjective accounts due to limited objective assessment methods available. The aim of this mixed-methods feasibility study is to develop an assessment method for FOF while in motion and walking within virtual environments. This study will assess a range of FOF-related responses, including cognitive factors, neuromuscular response and postural stability.
METHODS AND ANALYSIS
This feasibility study will consist of four phases: the first two phases will include people without PD, while the other two will include people diagnosed with PD. Participants will be assessed for direct and indirect responses to real life, as well as virtual environment walking scenarios that may induce FOF. Data from questionnaires, different neurophysiological assessments, movement and gait parameters, alongside evaluations of usability and acceptability, will be collected. Semistructured interviews involving both participants and research assistants shall take place to elicit their experiences throughout different phases of the assessments undertaken. Demographic data, the scores of assessment scales, as well as feasibility, usability and acceptability of the measurement methods, will be illustrated via descriptive statistics. Movement and gait outcomes, together with neurophysiological data, will be extracted and calculated. Exploring relationships between different factors in the study will be achieved using a regression model. Thematic analysis will be the approach used to manage qualitative data.
ETHICS AND DISSEMINATION
This feasibility study was approved by the Ethics Committee of the Faculty of Physical Therapy, Kafr El Sheikh University, Egypt (number: P.T/NEUR/3/2023/46). The results of this study will be published in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov Registry (NCT05931692).
Topics: Humans; Parkinson Disease; Postural Balance; Accidental Falls; Feasibility Studies; Fear; Egypt; Virtual Reality; Male; Female; Quality of Life; Aged; Middle Aged; Adult; Walking
PubMed: 38692713
DOI: 10.1136/bmjopen-2023-080592